Current technology: devices available for destination therapy.

Left ventricular assist device therapy as a destination therapy for end-stage heart failure has made a large leap with continuous flow devices. Continuous flow does not seem to have a detrimental effect on end-organ function, at least in the midterm. Various expected and unexpected complications have been reported associated with this technology.

Brain injury clinical trials: new agents or new statistics?

Failure of the vast majority of clinical trials evaluating recovery after severe brain injury from stroke or trauma has triggered interest in novel statistical techniques that are more powerful than conventional dichotomized outcomes. A retrospective analysis of data from a large international trial evaluating high-dose steroids for severe traumatic brain injury found that analysis of a wide range of outcome levels by using an ordinal scale with proportional odds regression or a sliding dichotomy was more likely to detect a treatment effect than the single-dichotomy approach. These techniques may soon become commonplace as critical care research increasingly focuses on patient-centered functional outcomes.

Why can insulin resistance be a natural consequence of thyroid dysfunction?

Evidence for a relationship between T4 and T3 and glucose metabolism appeared over 100 years ago when the influence of thyroid hormone excess in the deterioration of glucose metabolism was first noticed. Since then, it has been known that hyperthyroidism is associated with insulin resistance. More recently, hypothyroidism has also been linked to decreased insulin sensitivity.

A phase 2 randomized multicenter study of 2 extended dosing schedules of oral ezatiostat in low to intermediate-1 risk myelodysplastic syndrome.

Background: Ezatiostat is a glutathione analog prodrug glutathione S-transferase P1-1 (GSTP1-1) inhibitor. This study evaluated 2 extended dose schedules of oral ezatiostat in 89 heavily pretreated patients with low to intermediate-1 risk myelodysplastic syndrome (MDS).

Methods: Patients were randomized by 1 stratification factor-baseline cytopenia (anemia only vs anemia with additional cytopenias)-to 1 of 2 extended dosing schedules.

Does erlotinib restore chemosensitivity to chemotherapy in pancreatic cancer? A case series.

Erlotinib (Tarceva) in combination with gemcitabine is indicated for first-line treatment of patients with locally advanced, unresectable or metastatic pancreatic cancer. In preclinical models, exposure of pancreatic cancer cell lines to an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor plus gemcitabine suggested enhanced cytotoxicity of gemcitabine and induced apoptosis in tumor cells. Erlotinib inhibited gemcitabine-induced phosphorylation of EGFR, which may promote cytotoxicity from gemcitabine.

Low plasma triiodothyronine levels in heart failure are associated with a reduced anabolic state and membrane damage.

Background: Low plasma triiodothyronine (T(3)) levels are considered a prognostic predictor of death in heart failure (HF) patients.

Aim: To study an association between plasma T(3) levels and several cardiac, neurohormonal, and metabolic markers of HF.

Methods: A total of 133 ambulatory HF patients (114 males; mean age 63.

Cerebral perfusion pressure thresholds for brain tissue hypoxia and metabolic crisis after poor-grade subarachnoid hemorrhage.

Background And Purpose: To identify a minimally acceptable cerebral perfusion pressure threshold above which the risks of brain tissue hypoxia (BTH) and oxidative metabolic crisis are reduced for patients with subarachnoid hemorrhage (SAH).

Methods: We studied 30 poor-grade SAH patients who underwent brain multimodality monitoring (3042 hours). Physiological measures were averaged over 60 minutes for each collected microdialysis sample.

Adjuvant chemotherapy in 2011 for patients with soft-tissue sarcoma.

The mainstay of treatment for adults with soft-tissue sarcomas is wide surgical excision. Half of all patients with adequate local control of high-grade sarcomas develop distant metastases and, despite additional treatment, ultimately die from their disease. This daunting reality has resulted in a three-decade research effort to assess the efficacy of adjuvant therapy for adult soft-tissue sarcomas.

Quantitative analysis of hemorrhage volume for predicting delayed cerebral ischemia after subarachnoid hemorrhage.

Background And Purpose: Delayed cerebral ischemia (DCI) is an important complication after subarachnoid hemorrhage and appears to be associated with clot burden on CT. Quantification of hemorrhage on digitized images may be a more accurate method for predicting DCI than qualitative scales.

Methods: Quantitative analysis of clot burden on CT was performed in 160 subarachnoid hemorrhage patients who were scanned within 24 hours from the symptom onset between June 25, 2005 and July 19, 2009.

CoFactor: Folate Requirement for Optimization of 5-Fluouracil Activity in Anticancer Chemotherapy.

Intracellular reduced folate exists as a "pool" of more than 6 interconvertable forms. One of these forms, 5,10 methylenetetrahydrofolic acid (CH(2)THF), is the key one-carbon donor and reduced folate substrate for thymidylate synthase (TS). This pathway has been an important target for chemotherapy as it provides one of the necessary nucleotide substrates for DNA synthesis.

Safety and efficacy of panitumumab therapy after progression with cetuximab: experience at two institutions.

Introduction: Cetuximab therapy has been effectively combined with cytotoxic chemotherapy in the first-, second-, and third-line treatment settings. In general, treatment with cetuximab is well tolerated, though it has been associated with the development of hypersensitivity reactions (HSRs). In the case of severe HSRs, further therapy with cetuximab is not possible.

Intracerebral monitoring of silent infarcts after subarachnoid hemorrhage.

Background: Silent infarction is common in poor-grade subarachnoid hemorrhage (SAH) patients and associated with poor outcome. Invasive neuromonitoring devices may detect changes in cerebral metabolism and oxygenation.

Methods: From a consecutive series of 32 poor-grade SAH patients we identified all CT-scans obtained during multimodal neuromonitoring and analyzed microdialysis parameters and brain tissue oxygen tension (PbtO2) preceding CT-scanning.

Review of imaging techniques in the diagnosis and management of brain metastases.

Brain metastasis is one of the most common diagnoses encountered by neurologists, neurosurgeons, radiologists, and oncologists. The aim of this article is to review imaging modalities used in the diagnosis and follow-up of brain metastases. Through the use of various imaging techniques more accurate preoperative diagnosis and more precise intraoperative planning can be made.

Implantation technique of the CentriMag biventricular assist device allowing ambulatory rehabilitation.

Non-implantable ventricular assist device plays a major role in emergent or urgent situation where a patient has acutely decompensating hemodynamics. One of its major disadvantages is that the patient needs to be bed-bound after insertion. We have developed a surgical technique that allows ambulatory management of the patients who received non-implantable device with CentriMag.

Effect of mannitol on brain metabolism and tissue oxygenation in severe haemorrhagic stroke.

Background: The impact of osmotic therapies on brain metabolism has not been extensively studied in humans. The authors examined if mannitol treatment of raised intracranial pressure will result in an improvement in brain metabolism together with the expected drop in intracranial pressure (ICP).

Methods: This is a retrospective review of prospectively collected data.

Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Tumor necrosis factor-alpha (TNF-alpha) has a crucial role in the onset of hemolysis-induced vascular injury and cerebral vasoconstriction. We hypothesized that TNF-alpha measured from brain interstitial fluid would correlate with the severity of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). From a consecutive series of 10 aSAH patients who underwent cerebral microdialysis (MD) and evaluation of vasospasm by CT angiogram (CTA) or digital subtraction angiography (DSA), TNF-alpha levels from MD were measured at 8-hour intervals from aSAH days 4-6 using enzyme-linked immunosorbent assay.

Anemia is associated with metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage.

Background: Anemia is frequently encountered in critically ill patients and adversely affects cerebral oxygen delivery and brain tissue oxygen (PbtO2). The objective of this study is to assess whether there is an association between anemia and metabolic distress or brain tissue hypoxia in patients with subarachnoid hemorrhage.

Methods: Retrospective study was conducted in a neurological intensive care unit in a university hospital.

Myostatin activation in patients with advanced heart failure and after mechanical unloading.

Aims: Myostatin inhibits myoblast differentiation/proliferation and may play a role in heart failure (HF) and reverse remodelling after left ventricular assist device (LVAD) support. This study sought to characterize myostatin expression and activation in advanced HF before and after LVAD support.

Methods And Results: Left ventricular tissue pairs were collected at LVAD implantation (core) and at cardiac transplantation/LVAD explantation in patients with advanced ischaemic (ICM-ischaemic cardiomyopathy) and non-ischaemic (DCM-dilated cardiomyopathy) HF.

Systemic glucose and brain energy metabolism after subarachnoid hemorrhage.

Background: Brain energy metabolic crisis (MC) and lactate-pyruvate ratio (LPR) elevations have been linked to poor outcome in comatose patients. We sought to determine if MC and LPR elevations after subarachnoid hemorrhage (SAH) are associated with acute reductions in serum glucose.

Methods: Twenty-eight consecutive comatose SAH patients that underwent multimodality monitoring with intracranial pressure and microdialysis were studied.

How I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU.

Refractory status epilepticus (RSE) is associated with a high risk of poor outcome and treated by most neurointensivists with continuous intravenous antiepileptic medications (cIV-AEDs). Continuous EEG monitoring has allowed us to unveil a number of epileptiform patterns of less certain significance. These have been labeled ictal to interictal continuum (IIC), many of which are associated with poor outcome.

Eight-year experience with minimally invasive cardiothoracic surgery.

Background: Over the past decade, minimally invasive cardiac surgery (MICS) has emerged as an accepted approach for the management of cardiac disease that requires a surgical solution. We report the results of an 8-year, single-institution experience with MICS.

Methods: Between January 1, 2000 and December 31, 2007, a total of 910 patients underwent MICS.

Can a simple blood test quantify brain injury?

Despite significant advances in neurocritical care, it remains difficult to precisely measure the extent of neurological injury in patients affected by stroke, trauma, or cardiac arrest. In the intensive care unit the extent of primary and secondary injury often eludes clinicians, making prognostication imprecise and difficult. Derwall and colleagues present their findings on the dynamics of serum S-100B protein levels in out-of-hospital cardiac arrest survivors.

Continuous EEG monitoring: is it ready for prime time?

Purpose Of Review: Continuous electroencephalography (cEEG) is being used more frequently in intensive care units to detect epileptic activity and ischemia. This review analyzes clinical applications and limitations of cEEG as a routine neuromonitoring tool.

Recent Findings: cEEG is primarily used to detect nonconvulsive seizures, which are frequent and possibly associated with harm.